![]() Impacted mucus can also produce a bronchial cast, which is a semisolid occlusion within a bronchus that takes the shape of the airway within which it formed. Mucus plugs can partially or completely obstruct one or more airways and cause serious consequences, including atelectasis and recurrent infection. Consistency and flow of mucus can also be affected not only by pathologic structural abnormalities but also other factors, such as medications with anticholinergic properties. Mucus that is abnormally thick in consistency (ie, inspissated) and plugs the airway is known as a mucus plug. The composition of mucus may be altered by pathologic processes that cause stagnation of flow and blockage within the tracheobronchial tree. Examples of odor as a diagnostic clue include the rotten egg odor associated with anaerobic infections and the pungent smell often present in Pseudomonas infections. Examples of the appearance of sputum as a clinical clue include currant jelly sputum in Klebsiella infection, brown flakes in aspergillosis, and green sputum in infections caused by Pseudomonas organisms. 1 The appearance and odor of sputum has traditionally been used in clinical practice to help identify specific underlying lung conditions. The structure and composition of mucus and mucin glycoproteins have been extensively reviewed in the literature. ![]() Its precise composition varies depending on environmental and pathophysiologic conditions. Mucus is a complex mixture of mucin glycoproteins (mucins), water, ions, proteins, and lipids. Recognition of the characteristic appearance and differential diagnosis of mucus plugs will hopefully facilitate diagnosis and management of these diseases. In this review, we describe and illustrate the bronchoscopic, pathologic, and imaging findings in respiratory disorders characterized by mucus plugs or plugs composed of other similar materials. Other lung diseases occasionally associated with plugs within the airways include Aspergillus tracheobronchitis, hyper-IgE syndrome, exogenous lipoid pneumonia, pulmonary alveolar proteinosis, and chronic eosinophilic pneumonia. ![]() The best-known conditions that involve mucus plugs are allergic bronchopulmonary aspergillosis, plastic bronchitis, and asthma. The pathologic composition of these plugs is surprisingly diverse and, in many cases, correlates with distinctive clinical, radiologic, and bronchoscopic findings. Although mucus is a normal product of the tracheobronchial tree, some diseases of the respiratory tract are characterized by unusually thick (inspissated) forms of mucus that accumulate within the airways. ![]()
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